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Guidance for Medical Providers in Minnesota

Developed by: Minnesota Department of Health (MDH)
in consultation with: California Department of Public Health Sexually Transmitted Diseases (STD) Control Branch; New Mexico Department of Health; and the Centers for Disease Control and Prevention who allowed MDH to use their EPT guidances.

Subd. 2. Prescribing and filling.(a) A licensed practitioner in the course of professional practice only, may prescribe, administer, and dispense a legend drug, and may cause the same to be administered by a nurse, a physician assistant, or medical student or resident under the practitioner's direction and supervision, and may cause a person who is an appropriately certified, registered, or licensed healthcare professional to prescribe, dispense, and administer the same within the expressed legal scope of the person's practice as defined in Minnesota Statutes.

A licensed practitioner may prescribe a legend drug, without reference to a specific patient, by directing a nurse, pursuant to section 148.235, subdivisions 8 and 9, physician assistant, or medical student or resident to adhere to a particular practice guideline or protocol when treating patients whose condition falls within such guideline or protocol, and when such guideline or protocol specifies the circumstances under which the legend drug is to be prescribed and administered.

(f) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription or dispensing a legend drug in accordance with the Expedited Partner Therapy in the Management of Sexually Transmitted Diseases guidance document issued by the United States Centers for Disease Control.

Your sex partner has recently been treated for chlamydia. Chlamydia is a sexually transmitted disease (STD) that you can get from having any kind of sex (oral, vaginal, or anal) with a person who already has it. You may have been exposed. The good news is that it’s easily treated. You are being given a medicine called azithromycin (sometimes known as “Zithromax”) to treat your chlamydia. Your partner may have given you the actual medicine, or a prescription that you can take to a pharmacy. These are instructions for how to take azithromycin.

The best way to take care of this infection is to see your own doctor or clinic provider right away. If you can’t get to a doctor in the next several days, you should take the azithromycin. Even if you decide to take the medicine, it is very important to see a doctor as soon as you can, to get tested for other STDs. People can have more than one STD at the same time. Azithromycin will not cure other sexually transmitted infections. Having STDs can increase your risk of getting HIV, so make sure to also get an HIV test.

SYMPTOMS
Some people with chlamydia have symptoms, but most do not. Symptoms may include pain in your testicles, pelvis, or lower part of your belly. You may also have pain when you urinate or when having sex. Many people with chlamydia do not know they are infected because they feel fine.

BEFORE TAKING THE MEDICINE
The medicine is very safe. DO NOT TAKE if any of the following are true:

You are female and are pregnant, or have lower belly pain; pain during sex; vomiting; or fever.

You are male and have pain or swelling in the testicles or fever.

You have ever had a bad reaction, rash, breathing problems, or allergic reaction after taking azithromycin or other antibiotics. People who are allergic to some antibiotics may be allergic to other types. If you do have allergies to antibiotics, you should check with your doctor before taking this medicine.

You have a serious long-term illness, such as kidney, heart, or liver disease.

If you are currently taking another prescription medication, including medicine for diabetes, consult your pharmacist before taking the medication to ask about drug interactions

If any of these circumstances exist, or if you are not sure, do not take the azithromycin. Instead, you should talk to your doctor as soon as possible. Your doctor will find the best treatment for you.

WARNINGS

If you do not take medicine to cure chlamydia, you can get very sick. If you are a woman, you might not be able to have children.

If you are pregnant, seek medical evaluation before taking the medicines.

HOW TO TAKE THE MEDICINE

You can take these pills with or without food. However, taking these pills with food decreases the likelihood of having an upset stomach and will increase the amount of medicine your body absorbs.

You need to take all the pills you were given to be cured.

Do NOT take antacids (such as Tums, Rolaids, or Maalox) for one hour before or two hours after taking the azithromycin pills.

Do NOT share or give this medication to anyone else.

SIDE EFFECTS
Very few people experience any of these problems. Possible side effects include:

Slightly upset stomach;

Diarrhea;

Dizziness;

Vaginal yeast infection.

These are well-known side effects and are not serious.

ALLERGIC REACTIONS
Allergic reactions are rare. If you have ever had a bad reaction, rash, breathing problems or other allergic reactions with azithromycin or other antibiotics, consult your doctor or pharmacy before taking.
Possible serious allergic reactions include:

Difficulty breathing/tightness in the chest;

Closing of your throat;

Swelling of your lips or tongue;

Hives (bumps or welts on your skin that itch intensely).

NEXT STEPS

Now that you have taken your azithromycin, do not have sex for the next seven days. It takes seven days for the medicine to cure chlamydia.

If you have sex without a condom, or with a condom that breaks, during those first seven days, you can still pass on the infection to your sex partners.

If you have any other sex partners, tell them you are getting treated for chlamydia, so they can get treated too.

People who are infected with chlamydia once are very likely to get it again. It is a good idea to get tested for chlamydia and other STDs three months from now to be sure you did not get another infection.

Congratulations on taking good care of yourself! If you have any questions about the medicine, contact your partner’s healthcare provider. For more information about chlamydia or other STDs, or to find STD testing in your area, please call the Minnesota Family Planning and STD Hotline at 1.800.78FACTS (1.800.783.2287 voice/TTY) or visit www.inspot.org/minnesota.

DIRECTIONS FOR SEX PARTNERS OF PERSONS
WITH GONORRHEA AND DIRECTIONS FOR SEX PARTNERS OF PERSONS WITH GONORRHEA AND CHLAMYDIA

PLEASE READ THIS VERY CAREFULLY

Your sex partner has recently been diagnosed with one or more sexually transmitted diseases (STDs). This means you may have been exposed to chlamydia and/or gonorrhea. You can get chlamydia and gonorrhea from having any kind of sex (oral, vaginal, or anal) with a person who already has them. The good news is that they are easily treated. You are being given two different types of medicine. To cure gonorrhea you are receiving cefixime (sometimes known as “Suprax”) or cefpodoxime (sometimes known as “Vantin”). The other is called azithromycin (sometimes known as “Zithromax”). It will cure chlamydia. Your partner may have given you both medicines, or a prescription that you can take to a pharmacy. These instructions are for how to take cefixime, cefpodoxime and azithromycin.

The best way to take care of these infections is to see your own doctor or clinic provider right away. If you can’t get to a doctor in the next several days, and you were given both medications, you should take both. Even if you decide to take the medicines, it is very important to see a doctor as soon as you can to get tested for other STDs that these medications may not cure. Having STDs can increase your risk of getting HIV, so make sure to also get an HIV test.

SYMPTOMS
Some people with chlamydia and gonorrhea have symptoms, but many do not. Symptoms of chlamydia and gonorrhea may include having an unusual discharge from the penis, vagina, or anus. You may also have pain when you urinate, or pain in your groin, testicles, pelvis, or lower belly. Women may experience pain during sex. Many people with chlamydia and gonorrhea do not know they are infected because they feel fine.

BEFORE TAKING THE MEDICINE
The medicines are very safe. DO NOT TAKE if any of the following are true:

You are female and are pregnant, or have lower belly pain; pain during sex; vomiting; or fever.

You are male and have pain or swelling in the testicles or fever.

You have one or more painful and swollen joints, or a rash all over your body.

You have ever had a bad reaction, rash, breathing problems, or allergic reaction after taking cefpodoxime, cefixime, azithromycin, or other antibiotics. People who are allergic to some antibiotics may be allergic to other types. If you do have allergies to antibiotics, you should check with your doctor before taking these medicines.

You have a serious long-term illness, such as kidney, heart, or liver disease.

You are currently taking another prescription medicine, including medicine for diabetes.

If you are currently taking another prescription medicine, including medicine for diabetes consult your doctor or a pharmacist before taking the medication to ask about drug interactions.

If any of these circumstances exist, or if you are not sure, do not take these medicines. Instead, you should talk to your doctor as soon as possible. Your doctor will find the best treatment for you.

WARNINGS

If you performed oral sex on someone who was infected with gonorrhea, the medicine may not work as well. You need to see a doctor to get stronger medicine.

If you do not take medicine to cure chlamydia or gonorrhea, you can get very sick. If you’re a woman, you might not be able to have children.

If you are pregnant, seek medical evaluation before taking the medicines

HOW TO TAKE THE MEDICINE

Take the medicines with food. This will decrease the chances of having an upset stomach, and will increase the amount your body absorbs.

Take all pills with water at the same time. You need to take all pills in order to be cured.

Do NOT take antacids (such as Tums, Rolaids, or Maalox) for one hour before or two hours after taking the medicines.

Do NOT share or give these medicines to anyone else.

SIDE EFFECTS
Very few people experience any of these problems. Possible side effects include:

Slightly upset stomach;

Diarrhea;

Dizziness;

Vaginal yeast infection.

These are well-known side effects and are not serious.

ALLERGIC REACTIONS
Allergic reactions are rare. If you have ever had a bad reaction, rash, breathing problems or other allergic reactions with azithromycin or other antibiotics, consult your doctor or pharmacy before taking.
Possible serious allergic reactions include:

Difficulty breathing/tightness in the chest;

Closing of your throat;

Swelling of your lips or tongue;

Hives (bumps or welts on your skin that itch intensely).

NEXT STEPS

Now that you have your medicines, do not have sex for the next seven days after you have taken the medicines. It takes seven days for the medicines to cure chlamydia and gonorrhea. If you have sex without a condom, or with a condom that breaks, during those first seven days, you can still pass on the infection to your sex partners.

If you have any other sex partners, tell them you are getting treated for chlamydia and gonorrhea, so they can get treated too.

If you think you do have symptoms of a sexually transmitted disease and they do not go away within seven days after taking these medicines, please go to a doctor for more testing and treatment.

People who are infected with chlamydia and gonorrhea once are very likely to get infected again. It is a good idea to get tested for chlamydia, gonorrhea and other STDs three months from now to be sure you did not get another infection.

Congratulations on taking good care of yourself! If you have any questions about the medicine, contact your partner’s healthcare provider. For more information about chlamydia, gonorrhea or other STDs, or to find STD testing in your area, please call the Minnesota Family Planning and STD Hotline at 1.800.78FACTS (1.800.783.2287 voice/TTY) or visit www.inspot.org/minnesota.

Patients may experience anger, embarrassment, fear, and discomfort upon learning that they have an STD. This may be exacerbated when they realize they need to disclose this information to partners and see that they receive treatment. To help patients better understand the importance of partner treatment, providers can discuss the following:

If the partner does not receive treatment, and they have sex again, there is a great likelihood that the patient will become reinfected.

If people are unaware they have the infection and/or do not get treated, they can develop serious health complications.

If a partner does not get treated, he/she can spread the infection to other partners, now or in the future.

Providers can coach their patients on the most successful ways to initiate this difficult conversation. Whenever possible, offer patients the opportunity to talk through how to best approach their partners before leaving the exam room when the option of EPT has been decided.

There are additional key messages that should be conveyed to patients and their partner(s) when EPT is prescribed:

Partners should read the informational material very carefully before taking the medication.

Partners who have allergies to antibiotics or who have serious health problems should not take the medications and should see a healthcare provider.

Partners should seek a complete STD evaluation as soon as possible, regardless of whether they take the medication.

Partners who have symptoms of a more serious infection (e.g., pelvic pain in women, testicular pain in men, fever in women or men) should not take the EPT medications and should seek care as soon as possible.

Partners who are or could be pregnant should seek care as soon as possible.

Patients and partners should abstain from sex for at least seven days after treatment and until seven days after all partners have been treated, in order to decrease the risk of recurrent infection.

Partners should be advised to seek clinical services for re-testing three months after treatment.

ROOM 111 (Ramsey County Public Health)
555 Cedar Street, St. Paul MN
651-266-1352
The Room 111 Clinic, a part of Ramsey County Department of Public Health, provides diagnosis and treatment of STDs.

PLANNED PARENTHOODwww.plannedparenthood.org
Planned Parenthood has health centers all over the country, including 22 in Minnesota. Each center offers high quality sexual and reproductive health care, gynecological care, family planning, STI/STD testing and treatment and abortion services.

MINNESOTA FAMILY PLANNING AND STD HOTLINEwww.sexualhealthmn.org/
A toll-free hotline for confidential information about the prevention, testing locations and treatment of STDs in Minnesota.
1-800-78-FACTS (1-800-783-2287 voice/TTY)

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